Treatment of Telangiectases and Starburst Veins


What are telangiectases?

Small dilated facial blood vessels, known as telangiectases, are most common on the nose and cheeks. They can appear as an isolated event or be the first sign of rosacea. The flat red facial spots of rosacea (Grade I) are caused by the accumulation of telangiectases. Often the vessels slowly increase in number and later smaller papules (bumps) and pustules (pus-filled lesions) develop, indicating the transition to rosacea (Grade II). The treatment of these telangiectases is best accomplished with intense pulsed light (IPL).


How does intense pulsed light (IPL) therapy work?


IPL therapy employs visible and non-visible light with wave lengths of 400 - 1200 nm which are directed into the tissue. I use the Palomar StarLux® device with the LuxG handpiece. The target structures for the high-energy light are hemoglobin, the molecule responsible for the red color of blood in the small vessels and melanin, the dark pigment of skin. There targets are heated, destroyed and then degraded by the body. The treatment should only be performed on non-tanned skin. The dilated vessels become occluded, are resorbed and thus become invisible. The pigment is discharged through the skin. In addition, the structure of the skin becomes more uniform through the induction of collagen synthesis. Usually 3-4 treatments at 2-4 weeks intervals are required to obtain an optimal result. The treatment is relative pain-free, so no anesthesia is necessary.


Immediately following IPL therapy some redness and sometimes mild swelling are to be expected. Early treatment with cold packs speeds the healing process; by the next day, the redness is gone. The pigment may be seen as small dark crusts - much like finely ground pepper. Regular sun protection is crucial during the entire treatment cycle in order to avoid pigmentary changes during the healing period. Thus the winter months are ideally suited for treating telangiectases and rosacea (Grade I). IPL therapy makes it possible to gently remove these subtle changes often left by the passage of time. After the multiple sessions, the skin has a more uniform color and finer texture.


What are starburst veins?

Dilated small vessels on the legs can be an isolated constitutional problem or an early sign of varicose veins. The red or red-blue vessels develop net-like patterns in the superficial layers of the skin; they are most common on the thighs and calves. They have many names; starburst simply describes their radiating pattern from a central vessel.


Either sonography or duplex sonography of the superficial and deep leg veins should be performed prior to treating starburst veins, in order to exclude any disorders of the venous system.


How are starburst veins treated?


The standard approach is sclerotherapy. A sclerosing agent, usually polidocanol in 0.25-0.5% concentration is injected directly into the starburst vein using the finest of needles. The sclerosing agent spreads locally through the lesion and elicits an inflammatory reaction in the vessel wall which in turn causes occlusion of the vessel. The occluded vessel is over time resorbed and thus the starburst vein eliminated.

In microfoam sclerotherapy the polidocanol solution is converted to foam to insure an even better vessel occlusion. The foam with its tiny bubbles (mixture of air and liquid sclerosing agent) is injected into the starburst veins with a fine needle. The advantages of this technique are that the blood is forced out of the vessel and that the sclerosing agent stays in contact with the vessel wall for a longer period of time. Foam sclerotherapy can also be used to treat larger vessels.

The sclerosing fluid is degraded by the body over 48 hours. Such small amounts are injected that they are diluted by the blood stream and have only direct local effects. The treatment lasts around 30 minutes and in the hands of an experienced physician only slightly painful. Depending on the extent of the lesions, usually 3-4 treatment sessions at 2-4 week intervals are required to obtain optimal results. Solitary or a few vessels can often be eliminated in a single sitting.

Regular sun protection during the treatment cycle is required to minimize the risk of light-exacerbated hyperpigmentation at the sites of injection. Even less common complications include red discoloration (matting of even smaller capillaries), small scars or an inadequate response.

Superficial solitary starburst veins can also be treated with special lasers.


In a personalized consultation, I will be happy to discuss with you which therapeutic approaches are most appropriate for you.

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